medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Words Matter: Political and gender analysis of speeches made by
heads of government during the COVID-19 pandemic
Sara Dada1*, Henry Ashworth1,2, Marlene Joannie Bewa3,4, Roopa Dhatt4
1Vayu Global Health Foundation, Boston, MA, USA
2Harvard Medical School, Boston, MA, USA
3University of South Florida College of Public Health, Tampa, FL, USA
4Women in Global Health, Washington DC, USA
*Corresponding author: Sara Dada
Email: [email protected]
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 1 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Abstract
Background: The COVID-19 pandemic has put a spotlight on political leadership and decision-
making around the world. Differences in how leaders address the pandemic through public
messages have practical implications for building trust and an effective response within a
country.
Methods: We analyzed the public statements and speeches made by 20 heads of government
around the world (Bangladesh, Belgium, Bolivia, Brazil, Dominican Republic, Finland, France,
Germany, India, Indonesia, New Zealand, Niger, Norway, Russia, South Africa, Scotland, Sint
Maarten, United Kingdom, United States, Taiwan) to highlight the differences between men and
women leaders in discussing COVID-19 and pandemic response. We used a deductive analytical
approach, coding speeches for specific themes based on language used and content discussed.
Findings: Five primary themes emerged across a total of 122 speeches on COVID-19, made by
heads of government: economics and financial relief, social welfare and vulnerable populations,
nationalism, responsibility and paternalism, and emotional appeals. While all leaders described
the economic impact of the pandemic, women leaders spoke more frequently about the impact on
local or individual scale. Women leaders were also more often found describing a wider range of
social welfare services, including addressing to: mental health, substance abuse, and domestic
violence. Both men and women from lower-resource settings described detailed financial relief
and social welfare support that would impact the majority of their citizen population. While 17 of
the 20 leaders used war metaphors to describe the COVID-19 virus and response, men largely
used these with greater volume and frequency.
2 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Conclusion: While this analysis does not attempt to answer whether men or women are more
effective leaders in responding to the COVID-19 pandemic, it does provide insight into the
rhetorical tools and types of language used by different leaders during a national and
international crisis. This analysis provides additional knowledge on the importance and impact of
political leaders speeches, messages, and priorities to inspire citizens adhesion to the social
contract in the adoption of response and recovery measures.
3 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Background
The novel COVID-19 pandemic has shone a spotlight on political leadership and decision-
making around the world. These decisions made by political leaders have critical implications for
scientific research, vaccine development, healthcare delivery and systems, social and economic
policy measures to contain the pandemic and ultimately for the health, well-being and life of
citizens. In the current chaotic context, leadership and language matter; the ability of heads of
governments and global health authority figures to communicate publicly on the impact of
COVID-19 and the measures taken to mitigate risks are critical and closely scrutinized. Citizens’
perceptions, behaviors, and attitudes are significantly influenced by the type and quality of
information or public services announcements to which they are exposed.1
Responses to the pandemic have varied significantly across countries and continents and are
influenced not only by the magnitude of the pandemic, but also by pre-existing preparedness
mechanisms and national leadership. For example, politicians' statements are likely to have a
powerful impact on citizen’s adherence to social distancing measures or mask-wearing. A recent
study analyzing the context and chronology of presidential speeches in Brazil revealed the
relationship between statements made by President Bolsonaro on COVID-19 prevention
measures and adherence to social distancing policies.2 Additional research has noted that, while
the difference is not statistically significant, countries led by women have seen better public
health metrics in terms of COVID-19 response compared to countries led by men3. While risk
perception and health behaviors may be non-partisan in theory, citizens’ behaviors are likely
influenced by political leaders’ messages and calls to action or inaction.
4 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
At the time of writing, COVID-19 has not yet been eliminated in any but the smallest island
states; some countries that had low early mortality rates are experiencing a resurgence and a
second wave of infections is predicted before a vaccine is in widespread use. It would therefore
be premature to conclude that some countries have done better in pandemic response than others
since the picture may yet change. It is clear, however, that there are very different rhetorical
styles across political leaders and that further work is needed to analyze how these influence
public health messaging and public trust. In particular, it is worthwhile to consider if and how
these differences are influenced by gender. This study analyzes the public speeches and
statements made by heads of government in 20 countries around the world. The purpose is to
understand the different language, rhetoric, and priorities expressed by men and women leaders
in responding to the COVID-19 pandemic.
Methods
Setting
We set out to analyze official statements made by heads of government of the United Nations
Security Council (Belgium, China, Dominican Republic, Estonia, France, Germany, Indonesia,
Niger, Russian Federation, Saint Vincent and the Grenadines, South Africa, Tunisia, the United
Kingdom, the United States, Vietnam), BRICS (Brazil, Russia, India, China, South Africa), and
nation-states with women heads of government (Bangladesh, Barbados, Bolivia, Belgium,
Denmark, Finland, Germany, Iceland, Namibia, New Zealand, Norway, Scotland, Serbia, Sint
Maarten, Taiwan). We restricted the timeframe to February 26th and April 6th 2020 in order to
capture the month of March, the beginning of when COVID-19 was spreading rapidly around the
world and when international leaders began to respond actively. We recognize that gender is not
5 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
binary, but for the purposes of this study have categorized political leaders as “man” or “woman”
according to their assumed public gender identity, in the absence of other information on gender
identity.
Data collection
We searched for national addresses, statements, or speeches made to the public by all 29
countries’ heads of government (Appendix 1). Where fewer than two formal speeches were
available, we also searched for press briefings (including only the introductory statements made
by the head of government, before entertaining questions from the press), statements made to
governing bodies (speeches to parliament), and other statements aimed towards the general
public (podcasts, video announcements) and included these where available.
Written speeches were found on the public domain and via government websites. Where only a
video was available, the speech was transcribed and cross-checked by a native speaker. All non-
English speeches were translated into English using Google Translate and cross-checked by
speakers fluent in the original language. In order to have a comparable final dataset, we aimed to
include a range of geographic and political contexts that could be matched across the groups of
men and women heads of government. We also aimed for gender parity and included the
countries with the most available data in order to have a balanced pool. Table 1 exhibits the final
list of included countries and the number of statements made during the study period.
6 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Table 1: Included countries and number of speeches available
Country Leader Man/ Region Rationale for Number of Woman inclusion Speeches Bangladesh4 Hasina Woman Asia Woman 1 Belgium5 Wilmès Woman Europe UNSC, Woman 3 Bolivia6 Áñez Woman South America Woman 7 Brazil7 Bolsonaro Man South America BRICS 4 Dominican Republic8,9 Medina Man Caribbean UNSC 2 Finland10 Marin Woman Europe Woman 3 France11 Macron Man Europe UNSC 2 Germany12 Merkel Woman Europe UNSC, Woman 4 India13 Modi Man Asia BRICS 4 Indonesia14 Widodo Man Asia UNSC 5 New Zealand15 Ardern Woman Oceania Woman 3 Niger16 Issoufou Man Africa UNSC 2 Norway17 Solberg Woman Europe Woman 12 Russia18 Putin Man Europe/Asia BRICS, UNSC 2 Scotland19 Sturgeon Woman Europe Woman 14 South Africa20 Ramaphosa Man Africa BRICS, UNSC 3 Sint Maarten21 Jacobs Woman Caribbean Woman 12 Taiwan22 Ing-wen Woman Asia Woman 2 United Kingdom23 Johnson Man Europe UNSC 12 United States24 Trump Man North America UNSC 25
Analysis
Speech transcripts were uploaded and analyzed into NVivo. Two independent authors (SD, HA)
used a grounded theory approach to analyze the speeches and coded themes that emerged in the
data. A sample of six transcripts from different countries was used to develop the codebook
applied to the rest of the dataset and was checked for data saturation.
Ethical considerations
This research did not require an institutional board review approval. Data were collected online
from publicly available and accessible speeches and did not involve any human subjects.
7 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Results
A total of 20 countries across six continents were included in this analysis, with 122 speeches
analyzed. In the dataset of 122 speeches, 61 were delivered by women and 59 by men. Table 2
provides some contextual information on the included countries, such as democracy index and
gender development index scores and ranked by COVID-19 case count as of 30th June 2020
(Appendix 2 provides additional detail on COVID-19 context per country over time).
Table 2: Included countries ranked by COVID-19 case rate, including Democracy Index and
Gender Development Index scores
Country M/W Cases Per Democracy Democracy Gender Gender Capita as of Index Index Development Development 30 June25 201926 Index 201827 Index Group United States M 0.7667% 7.96 Flawed 0.991 1 Brazil M 0.6324% 6.86 Flawed 0.995 1 Belgium W 0.5300% 7.64 Flawed 0.972 2 United Kingdom M 0.4595% 8.52 Full 0.967 2 Russia M 0.4439% 3.11 Authoritarian 1.015 1 Scotland W 0.3473% N/A N/A N/A N/A Dominican Republic M 0.2933% 6.54 Flawed 1.003 1 Bolivia W 0.2701% 4.84 Hybrid 0.936 3 South Africa M 0.2432% 7.24 Flawed 0.984 1 France M 0.2404% 8.12 Full 0.984 1 Germany W 0.2319% 8.68 Full 0.968 2 Sint Maarten W 0.1796% N/A N/A N/A N/A Norway W 0.1633% 9.87 Full* 0.990 1 Finland W 0.1301% 9.25 Full 0.990 1 Bangladesh W 0.0861% 5.88 Hybrid 0.893 5 India M 0.0411% 6.90 Flawed 0.829 5 New Zealand W 0.0244% 9.26 Full 0.963 2 Indonesia M 0.0201% 6.48 Flawed 0.937 3 Niger M 0.0044% 3.29 Authoritarian 0.298 5 Taiwan W 0.0019% 7.73 Flawed N/A N/A
8 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Five major themes emerged across speeches: the economy and financial relief, social welfare and
vulnerable populations, nationalism, responsibility and paternalism, and emotional appeals.
While speeches and statements covered a wide range of content, these themes were where
differences in priorities and language across countries and across leaders were most distinct. Our
final interrater reliability, Kappa score, was 0.81, suggesting moderate to strong agreement
amongst coders28.
The Economy & Financial Relief
The economy was a central theme across leaders regardless of geography, level of gross
domestic product, or gender. Eighteen of the 20 leaders, excluding India’s Modi and
Bangladesh’s Hasina, specifically detailed the programs that would provide financial relief.
Seven leaders (3 women - Bolivia, Germany, Norway; 4 men - France, Indonesia, Russia, USA)
focused on small businesses across 20 speeches, while six leaders (3 women - Germany,
Norway, Scotland; 3 men - Dominican Republic, South Africa, USA) discussed large businesses
across 21 speeches. Informal economies were discussed by three leaders (1 woman - Norway; 2
men - Dominican Republic, South Africa) in five speeches.
All leaders were acutely aware of and highlighted the devastating economic impacts that
COVID-19 would have on their nations. Almost all leaders made reference to financial support
for families, small businesses, and larger corporations. However, there was a difference in how
men and women addressed this economic impact. Despite the near equal number of speeches
with economic references made across genders, this analysis demonstrates that women leaders
tended to prioritize discussing the economy at the level of individuals and small businesses,
9 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
while their men counterparts more often focused on larger businesses and corporations (Table
3). Besides emphasizing economic support for individuals and employees, a woman (Scotland’s
Sturgeon) was the only leader to discuss labor unions. This connects to a larger theme across
categories that women demonstrated a more people-centered approach compared to the men.
Table 3: Leaders’ references to small versus big businesses
Country Number of Number of Average Number of Number of Average References Speeches Reference References to Speeches Reference to Small (of total Coverage Big (of total Coverage Businesses speeches) per speech Businesses speeches) per speech Bolivia 5 3 (of 3) 5.30% ------Dominican ------2 1 (of 2) 1.77% Republic France 1 1 (of 2) 0.27% ------Germany 1 1 (of 4) 10.39% 2 1 (of 4) 5.28% Indonesia 1 1 (of 4) 3.03% ------Norway 4 2 (of 12) 4.05% 8 3 (of 12) 5.03% Russia 2 1 (of 2) 2.32% ------Scotland ------3 2 (of 14) 3.34% South Africa ------2 1 (of 3) 1.13% United States 28 14 (of 25) 2.69% 55 12 (of 25) 8.05%
Of the men who discussed economic support to smaller businesses, American President Donald
Trump and French President Emmanuel Macron stood out. Macron specifically focused on
providing unconditional support to business owners. On the 12th of March he stated:
“We will not add the fear of bankruptcy for entrepreneurs, concerns about unemployment
and the challenge of making ends meet at the end of the month to health worries. Every
effort will therefore be made to protect our employees and to protect our companies,
regardless of the cost”.11
Trump frequently discussed supporting small businesses, and referenced them in 14 of his 25
speeches. However, these references were few compared to the emphasis he put on addressing
10 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
large corporations and CEOs. The first topic Trump discussed in half of his first ten speeches
was the economic aspects of COVID-19, rather than the medical or health repercussions for
society. Men leaders tended to focus more on supporting large business and emphasizing overall
national economic recovery over individual support. This either came in subtle forms like
Brazilian President Jair Bolsonaro stating on the 31st of March, “We have a mission: to save
lives, without leaving jobs behind”7 or in more overt forms such as Trump directly naming and
thanking companies and inviting their CEOs to speak at formal press briefings, particularly on
the 13th, 15th, and 30th of March. Trump continually emphasized his cooperation and support of
larger businesses, and flagged how economic support was coming to ensure that they would not
suffer.
Women leaders who discussed supporting small businesses highlighted the importance of
protecting workers as well as individuals and families. Bolivia’s interim President Jeanine Áñez,
described on the 15th of March how programs for “small and medium-sized entrepreneurs who
are suffering and who will suffer due to this health crisis” would also “help Bolivian families
who will suffer an economic impact from the coronavirus.”6 In Scotland, First Minister Nicola
Sturgeon stated in an address on March 22nd, “To the vast majority of employers I say this – the
solution to the challenges that I know you are facing now is not key worker status. It is new shift
patterns, it is working from home, it is dropping non-essential tasks. And that is what you can do
to help all of us save lives.”19 Women leaders were also specific about their economic support
for small businesses. Finland’s Prime Minister Sanna Marin and Germany’s Chancellor Angela
Merkel both detailed financial programs and stimulus funds for small businesses.
11 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Vulnerable Populations & Social Welfare
German Chancellor Merkel described the relationship between the economic and social impacts
of the pandemic best in a speech on the 23rd of March with the statement, “many are
experiencing a social emergency due to the economic impact.”12 The COVID-19 pandemic has
catalyzed new social emergencies and deepened chronic challenges including social inequities.
While the two are intertwined, distinct vulnerable populations may require distinct forms of
social welfare. Just as the response to economic concerns varied across leaders, so did their
response to supporting new and longstanding vulnerable populations through different forms of
social welfare in their speeches.
With regards to specific vulnerable populations, only women heads of government noted the
vulnerability of migrants and refugees, individuals with mental health and substance use issues,
and victims of domestic violence. When women leaders spoke about and to these populations,
they did so with strong, empathetic and persuasive language. For example Bolivia’s Áñez
specifically called out and condemned all acts of violence perpetrated against women:
We have received many complaints about sexist violence and domestic violence during
these days of quarantine. I want to be very clear at this point. We are going to fall with
the full weight of the law before those who commit violence against women and against
families. And they already know me. I am going to be firm, I am going to be firm in the
defense of Bolivian women and families.6
12 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Immigrants, asylum seekers, and refugees have heightened vulnerability in this pandemic. The
only leaders to mention these populations, and describe support for them were Belgium’s Prime
Minister Sophie Wilmès and New Zealand’s Prime Minister Jacinda Ardern. For example on the
5th of April, Wilmès stated, “many decisions have also been taken in the field of mobility,
asylum and support for the most vulnerable people. These decisions were taken by the federal
government as a team, in collaboration with parliaments and the social partners.”5
Men and women both mentioned other vulnerable populations including children, the sick or
immunocompromised, and the elderly consistently across regions. These references were both in
relation to how collectively each country needed to take care of these populations, and also the
specific actions each government was taking. Typical comments include ones from Johnson on
the 12th of March, “The most important task will be to protect our elderly and most vulnerable
people during the peak weeks when there is the maximum risk of exposure to the disease and
when the NHS will be under the most pressure”23 and Sturgeon on the 17th of March, “Firstly,
people who are over 70, second people with underlying health conditions for which they get the
flu vaccine, and third women who are pregnant. We are strongly advising them to stay at home
as much as possible, and to significantly reduce unnecessary social contact.”19 Some leaders
particularly stood out including Norwegian Prime Minister Erna Solberg’s focus on children,
which included a press briefing specifically for children.
In terms of social welfare, all men and women leaders mentioned unemployment, healthcare
costs and access, food, and housing. Leaders of low and middle-income countries stressed access
to food. Examples include Bangladeshi Prime Minister Sheikh Hasina on the 25th of March,
13 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
“Assistance will be provided to low-income people in their respective villages under the
'Homecoming' program. Free house, 6 months food and cash will be provided to the homeless
and landless”4 and South African President Cyril Ramaphosa on the 30th of March, “The elderly
and the frail need people to care for them. Some of those who live on the streets are without
shelter or food.”20
Women leaders dove to a deeper depth on social welfare particularly related to the vulnerable
and need for social support. This was seen in how their mentioning less traditional, yet equally
necessary forms of social welfare including day care, mental health, and support for victims of
domestic violence and sexual assault. Only Áñez and Sturgeon directly addressed domestic
violence and measures to combat the reports of increased incidence during the pandemic.
Another example is Sturgeon’s comprehensive plan to provide equitable support for mental
health described on the 27th of March:
We are putting an additional £3.8 million immediately into the NHS’s mental health
support services. £0.5 million of that will support for the Breathing Space phone line and
web service, and £2.1 million will be for the NHS’s Mental Health Hub . . . The mental
health hub will expand its staffing in the coming weeks, so that it can become available to
the public 24 hours a day, 7 days a week.19
This focus was consistent across most women leaders and can be seen in how Sint Maarten’s
Prime Minister Silveria Jacobs mentioned it in over half of her speeches, often with specific
actions such as on the 20th of March, “designate the first hour of business to senior citizens, as
well as vulnerable persons such as pregnant women and persons with children. This is in order
to minimize contact.”21
14 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Nationalism
Reacting to a pandemic in a globalized society brings up an interesting dichotomy of national
versus international interests. In our analysis the theme of nationalism appeared in a number of
ways in leaders’ responses. These include actions such as enforcing border control and rhetoric
such as blame, advocacy for global cooperation, and urging a sense of patriotic duty and
sacrifice.
While only three leaders incorporated a tactic of blame in their speeches (Áñez, Bolsonaro, and
Trump), each did so to a different extent. Trump blamed a third party in 14 of his 25 speeches.
However, in only one speech on the 15th of March, Áñez said “we receive a very neglected and
flawed health system. So now our effort must be double.”6 This reflects a similar theme in
Trump’s speeches, such as on the 5th of April when he stated: “And you remember, we inherited
a broken system.”24 However, the biggest target of Trump’s blame remains China. He is the only
leader to consistently refer to COVID-19 as “the Chinese virus,” 24 rather than using its official
or scientific name. On the 14th of March, he stated: “It’s something that nobody expected. It
came out of China, and it’s one of those things that happened.”24 Beyond this, Trump and
Bolsonaro both blame China and the media for their roles in the pandemic. On the 24th of March,
Bolsonaro accused the media of stirring up panic in the country: “Considerable part of the media
went against the grain. They spread exactly the feeling of fear, with the announcement of the
large number of victims in Italy as their flagship.”7
15 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
While leaders of 13 countries (8 women – Bangladesh, Bolivia, Finland, Germany, New
Zealand, Norway, Sint Maarten, Taiwan; 5 men – Dominican Republic, France, Niger, South
Africa, USA) discussed limited international borders or suspending flights to or from specific
regions, Trump stressed travel restrictions taking an isolationist approach. On the 24th of March
he emphasized the need for self-reliance with:
We should never be reliant on a foreign country for the means of our own survival. I
think we’ve learned a lot. We’ve learned a lot. This crisis has underscored just how
critical it is to have strong borders and a robust manufacturing sector. . . America will
never be a supplicant nation. We will be a proud, prosperous, independent, and self-
reliant nation. We will embrace commerce with all, but we will be dependent on none.24
This mentality contrasted the emphasis several other leaders placed on global cooperation. Four
nations led by men discussed the value and importance of global cooperation (France, Niger,
UK, USA), while seven women-led nations did the same (Bangladesh, Bolivia, Finland,
Germany, Norway, Sint Maarten, Taiwan). Even amongst the men who did discuss global
cooperation, they discussed it far less, with just one mention each, except for Trump who on
three occasions described working with other nations referring to how America was “helping
other nations - many other nations; we’re helping them a lot.”24 On the 12th of March, Macron
stressed “This virus doesn’t have a passport. We need to join forces, coordinate our responses
and cooperate”11 and on the 17th Johnson simply said “while we need national unity, we also
need international cooperation.”23 On the 27th of March, Niger’s President Mahamadou Issoufou
highlighted the role of globalization:
16 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
I appeal to international solidarity to support the implementation of this plan. This
solidarity is more than ever justified because the increase in the speed of means of
transport has canceled the distances between regions of the world and between countries.
. . More solidarity and more equality, this must be the rallying cry, this must be the new
creed. We must share both the risks and the benefits of globalization.16
When considering the women, Marin, Merkel, and Solberg stressed collaboration across the
European region and Áñez emphasized cooperation with the World Health Organization. Sint
Maarten, as an overseas territory of the Netherlands and an island joined to a French territory of
similar name, has a unique political context that explains Jacobs’s common references to Dutch
and French and European aid in response. Taiwan has a similarly unique political context that
could explain President Ing-wen’s calls for “international responsibility [and] full international
cooperation.”22
A rhetorical tool used across leaders was the emphasis on patriotic duty to encourage sacrifice.
Twelve countries (7 men – Brazil, Dominican Republic, France, India, South Africa, UK, USA;
5 women – Bolivia, New Zealand, Norway, Scotland, Taiwan) used language calling on the
public to love their country, serve their nation, or come together as one. In 11 countries, this
went a step forward and called for self-sacrifice in the name of patriotism or service to the
greater common good (5 men – Dominican Republic, France, South Africa, UK, USA; 6 women
– Belgium, Bolivia, New Zealand, Norway, Scotland, Taiwan). Notably, some of the women
emphasized that this sacrifice is made for others – such as Wilmès’s statement on the 5th of
April: “The sacrifices we make are very great, especially for people who are alone”5 or Solberg
17 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
on the 12th of March: “We must put life and health first anyway. For each other. And for all
those we love.”17 Trump stressed sacrifice for the nation as a whole on at least six occasions,
including the 18th of March: “Every generation of Americans has been called to make shared
sacrifices for the good of the nation.”24 Johnson, Macron, Medina, and Ramaphosa focused on
acknowledging sacrifices or expressing gratitude for the sacrifices made by all citizens and
specific subgroups, such as healthcare providers.
Responsibility vs. Paternalism
Leaders included in this analysis often conveyed the importance of citizens taking actions to
protect themselves and adhere to governmental guidelines. This analysis highlights two forms of
emotional appeal used to convey this message: responsibility and paternalism. We defined
responsibility as rhetoric that encouraged individuals to act independently to adhere to guidelines
and paternalism as rhetoric that employed tactics such as shame, guilt, or punishment to
influence the desired behavior. Both men and women leaders used these tactics equally, without
a significant difference by gender. We found responsibility used by 15 of the leaders (8 men –
Dominican Republic, France, India, Indonesia, Russia, South Africa, United Kingdom, United
States; 7 women – Belgium, Bolivia, Germany, New Zealand, Norway, Scotland, Sint Maarten)
and paternalism used by 12 (6 men – Dominican Republic, France, India, Indonesia, South
Africa, United States; 6 women – Belgium, Bolivia, Germany, New Zealand, Scotland, Sint
Maarten)
18 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Leaders often balanced the use of paternalism and responsibility within a speech. One example
of this was seen in Ardern’s speech on March 23rd. Initially she used more paternalistic language
to emphasize the importance of adhering to guidelines:
That’s why sticking to the rules matters. If we don’t – if you hang out with that friend at a
park or see that family member for lunch, you risk spreading COVID -19 and extending
everyone’s time in Level 4. . . Failure to play your part in the coming days will put the
lives of others at risk. There will be no tolerance for that and we will not hesitate in using
enforcement powers if needed.15
This quote uses guilt of spreading COVID-19 and extending government restrictions as a means
of motivating compliance. She later concludes her speech with responsibility, particularly
focusing on empowering citizens to recognize the important role they play:
You may not be at work, but that doesn’t mean you don’t have a job. Your job is to save
lives, and you can do that by staying home, and breaking the chain. . .And finally, if you
have any questions about what you can or can’t do, apply a simple principle. Act like you
have COVID-19. Every move you then make is a risk to someone else. That is how we
must all collectively think. That’s why the joy of physically visiting other family, children,
grandchildren, friends, neighbours is on hold. Because we’re all now putting each other
first. And that is what we as a nation do so well. So New Zealand, be calm, be kind, stay
at home. We can break the chain.15
Other examples of responsibility include addressing the importance of personal responsibility
and taking ownership of the pandemic. This was displayed by South Africa’s President Cyril
Ramaphosa on March 30th, “Let us not make the mistake of thinking this is somebody else’s
19 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
problem;”20 Belgium’s Prime Minister Sophie Wilmès on March 19th, “Each of us has a role to
play. Not only to protect ourselves, but also to protect our loved ones and our fellow citizens”;5
and United Kingdom’s Prime Minister Boris Johnson on March 20th, “Each and every one of us
is now obliged to join together. To halt the spread of this disease. To protect our NHS and to
save many, many thousands of lives.”23 Here responsibility highlights social contracts and the
duty to protect other citizens. Paternalism was often partnered with language around the
enforcement of policies by other citizens or the government, as used by Ardern. Examples
include Indonesian President Joko Widodo on March 20th, “Don’t hesitate to reprimand those
who are not disciplined in keeping the distance, washing their hands, and maintaining their
health”14 and Sturgeon on March 22nd “My message to them is close now. We will have
emergency powers within days to force you to close and we will use these powers if we have to.
But you should not wait for that.”19 Collectively, paternalism and responsibility were important
tools of emotional rhetoric used by all leaders to motivate their citizens to adhere to newly
implemented guidelines.
Emotional Appeals
A common rhetorical tool throughout the pandemic, and even across infectious disease
discourse, is the use of war analogies – likening an outbreak to a war. Ten of the included leaders
specifically describe the pandemic as a “war” or “battle (5 women - Bangladesh, Bolivia,
Norway, Scotland, Taiwan; 5 men - Dominican Republic, France, India, United Kingdom,
United States). This number expands to 17 when we consider the use of any war rhetoric such as
words along the lines of “fighting” and “enemy.” As seen in Table 3, while this metaphor is used
across genders, the frequency and aggression of these analogies seems to be stronger with the
20 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
men. In the 19 speeches made by women who used war metaphors, they average 6.1 references
to this rhetoric. In the 40 speeches made by men with this language, they average 25.4 references
to war metaphors. For example, Trump used war analogies 136 times across 23 speeches,
Johnson 15 times across 7 speeches, Modi 30 times across all 4 of his speeches. Meanwhile, the
only woman to use this rhetoric in double digits was Áñez with 26 occurrences in her 5 speeches.
On average, for speeches that did employ war rhetoric or aggressive language, it constituted
3.5% of each speech made by men, and 2.8% for the women (1.9% without Áñez).
Table 4: Leaders’ use of war metaphors across speeches
Country Number of Number of Speeches Average Reference References (of total speeches) Coverage per speech Bangladesh 3 1 (of 1) 3.04% Belgium 9 3 (of 3) 3.19% Bolivia 26 5 (of 7) 10.00% Dominican Republic 1 1 (of 2) 0.61% Finland 1 1 (of 3) 1.37% France 9 1 (of 2) 3.65% India 30 4 (of 4) 5.39% Indonesia 2 1 (of 4) 1.96% New Zealand 4 2 (of 3) 2.21% Niger 7 2 (of 2) 3.95% Norway 4 2 (of 12) 1.60% Scotland 4 2 (of 14) 1.29% Sint Maarten 1 1 (of 12) 0.59% South Africa 2 1 (of 3) 1.49% Taiwan 3 2 (of 2) 1.87% United Kingdom 15 7 (of 12) 4.76% United States 136 23 (of 25) 4.51%
The language around war ranged in describing the battles, enemies, and weapons employed in
the fight against COVID-19. On 16th March, Macron states: “We are at war, admittedly a health
war: we’re fighting neither an army nor another nation. But the enemy is there, invisible,
elusive, and it’s making headway.”11 Four other leaders also describe the virus as an “invisible
enemy”16,17,23,24 (Issoufou, Johnson, Solberg, and Trump) and Johnson even declares it “the
invisible killer”23 on the 23rd of March, just days before announcing his own illness. Issoufou
21 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
and Ardern equate options for response to the pandemic to weapons. For example, on the 17th of
March Issoufou explains “The only weapon that exists today is prevention.”16
Bolivia’s Áñez was the woman leader with the most war references, for example expressing on
the 15th of March: “I will dedicate 100% of my time to fighting for the health of Bolivians. It will
be a tough battle and it will be a long one but I want you to know that it is a battle that we are
going to win if we do it among all Bolivians.”6 In observing Áñez’s use of this language, it is
relevant to consider the context of her political power as well. In addition to being the only
woman in this dataset to reference war in the double digits, she is also the only leader in this pool
who came to power after a coup. It is worth noting how the political and societal context of the
country, Bolivia, could influence the language used by their head of government. Notably, both
times Ing-wen employs the war metaphor, it is to describe the necessity for “full international
cooperation [as] the only way to ensure that the international community can win this battle.”22
In the case of Ing-wen, it is worth noting that Taiwan is the smallest state included in this
analysis and it is possible that its contested relationship with China influences views on
globalization and international cooperation.
Trump is not the only leader to utilize this blasé tone. This is another similarity amongst a group,
though not all, of the men leaders. In Brazil, India, the UK, and the US, heads of government
often dismissed the severity and concern over COVID-19. On the 24th March, Bolsonaro
explained, “In my particular case, due to my athlete's history, if I was infected by the virus, I
would not have to worry, I would not feel anything or I would be, at most, suffering from a light
flu or a light cold, as the well-known doctor from that well-known television said.”7 This
22 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
personal nonchalance was clear in another speech a week later when he said “The coronavirus
came and one day it will go away, unfortunately we will have losses along the way.” Similarly,
Modi and Johnson stress that “everything is okay”13 and the need for “going about our business
as usual,” 23 respectively. This same attitude is demonstrated in the way Trump discusses the
voluntary nature of wearing face masks on the 3rd of April: “So with the masks, it’s going to be,
really, a voluntary thing. You can do it. You don’t have to do it. I’m choosing not to do it, but
some people may want to do it, and that’s okay. It may be good. Probably will. They’re making a
recommendation. It’s only a recommendation. It’s voluntary.”24
This approach is a stark contrast to the language employed by some of the women leaders in this
analysis. It was more common for women to stress empathy and compassion in their speeches to
the public. One poignant example is Norway’s press briefings held specifically for children. On
multiple occasions, Solberg held these events to answer the questions and concerns of the
nation’s children, including on the 16th of March when she said: “Many children find this scary.
I understand that well. It's allowed to get a little scared when so many big things happen at once.
It is allowed to be a little scared to get infected by the coronavirus.”17 Women leaders such as
Áñez and Ardern also empathized with parents and families by stressing their experiences as
mothers. While the men leaders included in this analysis also have children, none of them
mentioned their roles as fathers or experiences with family. In the case of Scotland’s Sturgeon,
this empathy included messages to the families who have lost loved ones to COVID-19 during
the pandemic. Sturgeon began every speech with acknowledging the new deaths or
hospitalizations in the country and explicitly sharing her condolences with those families and the
public as a whole. She does this with honesty and compassion, for example on the 5th of April
23 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
with, “The figure I will report tomorrow, is likely to be artificially low – though of course, each
one matters and is a source of sadness to family and friends but also to me.”19
Women leaders including Áñez, Ardern, Jacobs, Merkel, and Sturgeon called on their
constituents to employ this empathy in their adherence to various restrictions and policies that
may have been implemented. On the 19th of March, Merkel stressed: “These are not just abstract
numbers in statistics, but this is about a father or grandfather, a mother or grandmother, a
partner – this is about people. And we are a community in which each life and each person
counts.”12 Áñez used similar language on the 25th of March, asking the audience to think of their
parents and grandparents who took care of them in the past and needed to be protected now.
Ardern and Sturgeon emphasize a need to “be kind”15,19 and Jacobs implores society to “show
love and caring to one another.”15
The strongest emotional appeal from the men leaders came from the Dominican Republic’s now
Former President Danilo Medina. Both of his speeches in March included vivid calls for
solidarity and compassion, and on the 17th of March he concluded his speech with:
It is true, we are facing the most serious public health alert in recent decades, but we are
also facing one of the moments in history that shows us the true greatness of human
beings. Being a Dominican has always meant facing challenges with courage and facing
the future with optimism and this time will be no exception. Let's not let fear cloud our
gaze. Let us divest ourselves of all selfishness and see in each compatriot a member of
our great family. Let us act with temperance, with rationality and always thinking about
what is really important, what should unite us now, what we all want to preserve: the
24 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
health of our grandparents and parents, of all those who are now more vulnerable and,
of course, of our sons and daughters.9
Discussion
The purpose of this study is to analyze how a leaders’ gender may relate to their communication
style during the initial response to the COVID-19 pandemic, rather than to declare whether
countries led by men or women managed the early months of the pandemic more effectively. In
this study, we specifically focus on the content of communications by heads of government, their
communication style, and the differences in these approaches. It is important to note that these
differences are influenced by more than just gender – such as geographic context, political
ideologies, socio-economic context, political history of the country, and population
demographics. However, our analysis shows that there are notable differences between men and
women heads of government with practical implications for pandemic response.
This analysis highlights noticeable differences between the content men and women leaders used
related to economics and social welfare and how they made emotional appeals to the public.
While all leaders acknowledged the economic impacts of the pandemic, women were more likely
to cite the impact on the micro-scale, emphasizing the impact on individuals and families. This
continued in the way men and women leaders described social welfare mechanisms versus
financial relief. In particular, only women acknowledged the impact of the pandemic on unique
vulnerable groups including migrants and refugees, substance abusers, people with mental health
challenges, and its impact on family care responsibilities and domestic violence. While we did
not assess governments’ actual programmatic responses or policies, the focus on vulnerable
25 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
populations by women heads of government demonstrates the prioritization of vulnerable
populations and social cohesion in response.
Previous studies have described how the message-framing of leaders can influence decision-
making processes and behavior on micro and macro scales – from vaccination behavior to trust
in outbreak preparedness.2,29-31 According to the agenda-setting research paradigm32, messages
highlighted in media or by leaders influence the selection and prioritization of issues in society
as well as policy-agenda-setting. In fact, messages shared by opinion leaders through media are
more likely to impact policy both by shaping public perception of risk and by shaping policy
makers’ perception of public opinion. Government communication style is therefore likely to be
associated with perceptions, responses to health threats, resulting in health, social, and economic
outcomes for the public and nation.33 For example, President Obama’s use of the term
“epidemic” rather than “outbreak” during the 2014-2016 West Africa Ebola epidemic
transformed the language being used by the media to describe the growing emergency.34 This
transition of terminology went beyond semantics, affecting the conceptualization of the crisis
and therefore the resulting response.
Another clear difference across genders was the varying approaches in making emotional
appeals. Across the board, men tended to use more war rhetoric while women tended to employ
personal or empathetic appeals. Language that uses imagery of battles and threatening enemies
can be a powerful tool to invoke fear in the audience.35 As examples, Prime Minister Johnson
explicitly stated that “we must act like any wartime government and do whatever it takes to
support our economy”23 and President Trump demonstrated this very clearly in discussing the
26 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
virus and the government’s response. Times of war require unprecedented action from the
government in order to protect the populace. However, the fear and sense of urgency invoked by
this language can also be used as a justification for a lack of transparency.36,37
Approaching the COVID-19 pandemic as a war has a strong influence on response mechanisms
and proposed policies. In times of crisis, those in charge may be quick to fall back on existing
structures of response that are not transparent.38 The decisions made in these times, particularly
in attempting to mitigate a disease outbreak, will invariably affect and rely on the public. Yet,
when decisions are taken behind closed doors, how they communicated to the public impacts on
public trust and compliance with public health measures. It is precisely and especially during
emergencies that the public requires transparent procedures and clearly communicated decisions.
Building trust and enabling accountability depend on it, underpinning not only an efficient
outbreak response but also an effective health system.39Accountability and transparency are
critical to earn the public’s trust and shared information must be evidence-based. Elected
officials must have some level of understanding of health and risk communication in order to
communicate effectively in times of health crises, as well as the skills to translate science into
policy to ensure evidence-based priorities and policy implementation.40
The empathetic and personal appeals that women made focused on compassion and social
cohesion, such as Chancellor Merkel’s comment, “these are not just abstract numbers in
statistics, but this is about a father or grandfather, a mother or grandmother, a partner – this is
about people. And we are a community in which each life and each person counts.” Similar
comments asking for compassion for others were seen consistently throughout speeches made by
27 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
women. Commentators have picked up on these emotional appeals as being vital for generating
social cohesion to generate a unified public response.41 In particular, Prime Minister Ardern has
been hailed for her ability to generate trust through transparency and action through the social
cohesion she inspires.42 Empathic statements and war rhetoric may both inspire a form of unity,
but they have important practical differences. While war rhetoric plays to a collectivism based
upon fear and division, empathy appeals to a collectivism based upon compassionate social
cohesion.43 A fear-based approach may instigate conflict and marginalization.44,45
Limitations
There are several limitations to this study. As with qualitative research, there is a limit to the
comparability and generalizability of the data analyzed. This study relied on publicly available
data that could be transcribed or translated to English with limited resources, which also made
some speeches subject to errors in transcription and translation. Due to this and other differences
amongst countries, the number of speeches from each country varies greatly. However, it is
worth noting that there were roughly the same amount of speeches from men (n=59) and women
(n=61) included. In identifying gender we did not directly ask heads of government for their
gender identity, but instead relied upon gender identities reported in the news and through
pronouns in speeches. We acknowledge, however, that gender is complex, self-identified, non-
binary, and socially produced. Finally, countries have been impacted differently by the pandemic
(incidence, prevalence, mortality rate) and have had different experiences with managing public
health emergencies, which can affect their response, priorities, political and risk communication
styles. This study did not consider this historical context nor the societal and political ideals and
values that influence individual leaders, the language they use, and political priorities.
28 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Conclusion
While this analysis does not attempt to answer whether men or women are more effective leaders
in responding to the COVID-19 pandemic, it does provide insight into the rhetorical tools and
types of language used by different leaders during a national and international health crisis. This
language matters because it influences how leaders inspire citizens’ compliance with response
and recovery measures. This analysis explores how men and women heads of government tend
to use different types of language. There are certainly exceptions, but this study points to how
imperative communication is in shaping a public health response through dialogue and building
public trust.
We have seen in previous disease outbreaks, and during the COVID-19 pandemic, how a fear-
based or nonchalant narrative can be disastrous for an effective response.46-49 This highlights the
critical role that communication plays in public health.50 There is more to learn about how the
discourse around COVID-19 influences the pandemic response, however the impacts of this
pandemic are far-reaching and far from over. We specifically illustrate important differences
around gender, which should be further explored in future studies and related to effective
response. As our world becomes more globalized and public health matters affect all of us, this
era will reshape how public facing officials discuss both response and recovery policies. As a
result, there is a need for more robust studies on communications in public health as we consider
how the way we communicate will affect vaccine deployment, economic and social recovery,
and more. While it has been overlooked in the past, this study contextualizes the importance of
language, through a gender lens, in building both trust and an effective public health response.
29 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
Author Contributions
SD developed the study methodology with the guidance of RD and collected the data for this
study. SD and HA conducted the analysis and wrote the initial draft, with key input from MJB.
RD provided edits and feedback. All authors revised the manuscript before submission
Funding
This research received no specific grant from any funding agency in the public, commercial, or
not-for-profit sectors.
Competing Interests
We wish to confirm that there are no known conflicts of interest associated with this publication
and there has been no financial support for this work that could have influenced its outcome. We
confirm that this body of work has not been published elsewhere, nor is it currently under
consideration for publication elsewhere.
Acknowledgments
The authors would like to acknowledge Salla Atkins (Tampere University, Finland), Veronica
Velasquez (Northwestern Trauma and Surgical Initiative, USA), Kaushi Ratnayake (Harper and
Keele Veterinary School, UK), Alina Sobitschka (University of Göttingen, Germany), Andreia
Bruno-Tomé (Monash University, Australia), Mehr Manzoor (Tulane University, USA), Daniela
Suarez-Rebling (Icahn School of Medicine at Mount Sinai, USA) for transcription and/or
30 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
translation assistance. We would also like to thank Rick Zednik (Women Political Leaders) and
Emma Kinloch (King’s College London, UK) for their feedback on methodology and approach,
Ann Keeling (Women in Global Health) for her review of the manuscript, and Lilly Khorsand
(Women in Global Health) for assisting with table graphics.
31 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
References
1. Antonakis J, d’Adda G, Weber R, Zehnder C. Just words? Just speeches? On the economic value of charismatic leadership. NBER Rep 4. 2014. 2. Ajzenman N, Cavalcanti T, Da Mata D. More than words: Leaders’ speech and risky behavior during a pandemic. Available at SSRN 3582908. 2020. 3. Purkayastha S, Salvatore M, Mukherjee B. Are women leaders significantly better at controlling the contagion? medRxiv. 2020. 4. [Bangladesh]: ; 2020 [Available from: https://pmo.gov.bd/site/view/pm- speech/%E0%A6%9C%E0%A6%BE%E0%A6%A4%E0%A6%BF%E0%A6%B0- %E0%A6%89%E0%A6%A6%E0%A7%8D%E0%A6%A6%E0%A7%87%E0%A6%B6%E0%A7%8D %E0%A6%AF%E0%A7%87-%E0%A6%AD%E0%A6%BE%E0%A6%B7%E0%A6%A3. 5. Sophie Wilmés News [Belgium]: Belgium Premier; 2020 [Available from: https://www.premier.be/en/timeline. 6. Jeanine Añez President of Bolivia [Bolivia] 2020 [Available from: https://www.youtube.com/channel/UC7QjQXQopwIvJ9KfmYj7EAQ. 7. Últimos Pronunciamentos [Brazil]: Presidência da República; 2020 [Available from: https://www.gov.br/planalto/pt-br/acompanhe-o-planalto/pronunciamentos. 8. Ante el CoronaVirus Danilo Medina habla al pueblo Dominicano [Dominican Republic]: Gobierno Danilo Medina; 2020 [updated 25 March 2020. Available from: https://www.youtube.com/watch?v=-h3vYohxADw. 9. Discurso presidente Medina por covid-19 [Dominican Republic]: Noticias SIN; 2020 [updated 17 March 2020. Available from: https://www.youtube.com/watch?v=rk63OZw8VHE. 10. Speeches [Finland]: Finnish Government; 2020 [Available from: https://valtioneuvosto.fi/en/current-issues/speeches. 11. Official speeches and statements 2020 [France]: Embassy of France in the United States; 2020 [Available from: https://franceintheus.org/spip.php?rubrique501. 12. Live from the Chancellery [Germany]: Die Bundeskanzlerin; 2020 [Available from: https://www.bundeskanzlerin.de/bkin-de/mediathek/live-aus-dem-kanzleramt. 13. Text Speeches [India]: Narendra Modi; 2020 [Available from: https://www.narendramodi.in/category/text-speeches. 14. Speech Transcripts [Indonesia]: Cabinet Secretariat of the Republic of Indonesia; 2020 [Available from: https://setkab.go.id/en/category/speech-transcript/page/4/. 15. Rt Hon Jacinda Ardern [New Zealand]: The official website of the New Zealand Government; 2020 [Available from: https://www.beehive.govt.nz/minister/rt-hon-jacinda-ardern. 16. Speeches [Niger]: Présidence de la République du Niger; 2020 [Available from: https://www.presidence.ne/discours-du-prsident. 17. Finn aktuelt [Norway]: Regjeringen; 2020 [Available from: https://www.regjeringen.no/no/aktuelt/aktuelle_saker/id2000005/?ownerid=&documenttype=aktuelt/taler ogartikler&term=&page=4. 18. Transcripts [Russia]: President of Russia; 2020 [Available from: http://en.kremlin.ru/events/president/transcripts/page/4. 19. First Minister’s Speeches [Scotland]: Scottish Government; 2020 [Available from: https://www.gov.scot/collections/first-ministers-speeches/#2020. 20. Speeches [South Africa]: South African Government; 2020 [Available from: https://www.gov.za/speeches. 21. Government of Sint Maarten [Sint Maarten] 2020 [Available from: https://www.youtube.com/channel/UC1bIsTYvgBE1AZ75j9HlSBA.
32 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
22. News & activities [Taiwan]: Office of the President Republic of China (Taiwan); 2020 [Available from: https://english.president.gov.tw/Page/35. 23. News and communications, Prime Minister’s Office, 10 Downing Street [United Kingdom]: United Kingdom Government; 2020 [Available from: https://www.gov.uk/search/all?parent=prime- ministers-office-10-downing- street&content_purpose_supergroup%5B%5D=news_and_communications&organisations%5B%5D=pri me-ministers-office-10-downing-street&order=updated-newest. 24. Briefings & Statements [United States]: White House; 2020 [Available from: https://www.whitehouse.gov/briefings-statements/?issue_filter=healthcare. 25. Coronavirus disease (COVID-19): Situation Report – 162 World Health Organization; 2020 30 June 2020. 26. Democracy Index 2019. The Economist Intelligence Unit; 2020. 27. Human Development Reports: Gender Development Index (GDI). United Nations Development Programme. 28. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276- 82. 29. Yano M. Covid-19 Pandemic and Politics: The Cases of Florida and Ohio. Research Institute of Economy, Trade and Industry (RIETI); 2020. 30. Broom J, Broom A, Bowden V. Ebola outbreak preparedness planning: a qualitative study of clinicians' experiences. public health. 2017;143:103-8. 31. Hendrix KS, Finnell SME, Zimet GD, Sturm LA, Lane KA, Downs SM. Vaccine message framing and parents’ intent to immunize their infants for MMR. Pediatrics. 2014;134(3):e675-e83. 32. McCombs ME, Shaw DL. The agenda-setting function of mass media. Public opinion quarterly. 1972;36(2):176-87. 33. Kim DKD, Kreps GL. An Analysis of Government Communication in the United States During the COVID‐19 Pandemic: Recommendations for Effective Government Health Risk Communication. World Medical & Health Policy. 2020. 34. Gesser-Edelsburg A, Shir-Raz Y, Bar-Lev OS, James JJ, Green MS. Outbreak or Epidemic? How Obama's Language Choice Transformed the Ebola Outbreak Into an Epidemic. Disaster Med Public Health Prep. 2016;10(4):669-73. 35. Shors L. Council on Foreign Relations. 2020. Available from: https://www.thinkglobalhealth.org/article/waging-another-public-health-war. 36. Khruschcheva NL. The Fog of COVID-19 Propoganda. Project Syndicate [Internet]. 2020. Available from: https://www.project-syndicate.org/commentary/trump-putin-covid19-war-rhetoric-by- nina-l-khrushcheva-2020-04. 37. Foucault M. Society Must be Defended: Lectures at the Collège de France, 1975-76: Lectures at the College De France, 1975 76. UK: Penguin. 2004. 38. vanDaalen K, Bajnoczk C, Chowdhury M, Dada S, Khorsand P, Socha A, et al. Symptoms of a broken system: the gender gaps in COVID-19 decision-making. BMJ Global Health [in press]. 2020. 39. Living with COVID-19: Time to get our act together on health emergencies and UHC. UHC 2030 International Health Partnership; 2020 27 May 2020. 40. Burkle Jr FM, Hanfling D. Political leadership in the time of crises: primum non nocere. PLoS currents. 2015;7. 41. Anderson C. Why Do Women Make Such Good Leaders during COVID-19? Forbes, April. 2020;19. 42. Friedman U. New Zealand’s Prime Minister may be the most effective leader on the planet. The Atlantic. 2020;19. 43. Royal SV. Fear, Rhetoric, and the ““Other””. Race/Ethnicity: Multidisciplinary Global Contexts. 2011;4(3):405-18. 44. Shen L. The effectiveness of empathy-versus fear-arousing antismoking PSAs. Health communication. 2011;26(5):404-15.
33 medRxiv preprint doi: https://doi.org/10.1101/2020.09.10.20187427; this version posted September 15, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
It is made available under a CC-BY-NC-ND 4.0 International license .
45. Ruiter RA, Kessels LT, Peters GJ, Kok G. Sixty years of fear appeal research: current state of the evidence. Int J Psychol. 2014;49(2):63-70. 46. Asmundson GJG, Taylor S. Coronaphobia: Fear and the 2019-nCoV outbreak. J Anxiety Disord. 2020;70:102196-. 47. Atkinson P. Open Democracy [Internet]2014. Available from: https://www.opendemocracy.net/en/ebola-crisis-exposing-failures-of-local-and-global-governance/. 48. Simpson JK. Appeal to fear in health care: appropriate or inappropriate? Chiropr Man Therap. 2017;25:27-. 49. Tumpey AJ, Daigle D, Nowak G. Communicating during an outbreak or public health investigation. CDC, Epidemic Intelligence Service[(accessed on 30 January 2020)]. 2018. 50. Qiu W, Chu C, Hou X, Rutherford S, Zhu B, Tong Z, et al. A Comparison of China’s Risk Communication in Response to SARS and H7N9 Using Principles Drawn From International Practice. Disaster Medicine and Public Health Preparedness. 2018;12(5):587-98. 51. Countries in the world by population (2020) Worldometer2020 [Available from: https://www.worldometers.info/world-population/population-by-country/. 52. Coronavirus disease (COVID-19): Situation Report – 40 World Health Organization; 2020 29 February 2020. 53. Coronavirus disease (COVID-19): Situation Report – 71. World Health Organization; 2020 31 March 2020. 54. Coronavirus disease (COVID-19): Situation Report – 101. World Health Organization; 2020 30 April 2020. 55. Coronavirus disease (COVID-19): Situation Report – 132 World Health Organization; 2020 31 May 2020. 56. Coronavirus - COVID-19 - Management Information: a data cube spreadsheet. Scottish Government; 2020.
34 preprint medRxiv preprint
Appendix Table 1: Inclusion/Exclusion of countries (which wasnotcertifiedbypeerreview)
COUNTRY Leader M/W inclusion Rationale Region reason for exclusion doi:
Belgium Wilmès W G10, UNSC, Woman Europe Included https://doi.org/10.1101/2020.09.10.20187427 France Macron M G10, UNSC Europe Included Germany Merkel W G10, UNSC, Woman Europe Included United Kingdom Johnson M G10, UNSC Europe Included It ismadeavailableundera United States Trump M G10, UNSC North America Included Brazil Bolsonaro M BRICS South America Included
Russia Putin M BRICS, UNSC Europe/Asia Included istheauthor/funder,whohasgrantedmedRxivalicensetodisplaypreprintinperpetuity. India Modi M BRICS Asia Included South Africa Ramaphosa M BRICS, UNSC Africa Included
Dominican Medina M UNSC Caribbean Included CC-BY-NC-ND 4.0Internationallicense
Republic ; Indonesia Widodo M UNSC Asia Included this versionpostedSeptember15,2020. Niger Issoufou M UNSC Africa Included Saint Vincent and Gonsalves M UNSC Caribbean Excluded – Speeches not available on public domain the Grenadines Tunisia Fakhfakh M UNSC Africa Excluded – Speech transcripts not available, no capacity to transcribe Arabic Vietnam Nguyễn Phú Trọng M UNSC Asia Excluded – Speech transcripts not available, no capacity to transcribe Vietnamese Bangladesh Hasina W Woman Asia Included . Barbados Mottley W Woman Caribbean Excluded – Only 1 speech available, other carribean nation chosen Bolivia Añez W Woman South America Included The copyrightholderforthis Denmark Frederiksen W Woman Europe Excluded – Only 1 speech available, other European countries already represented Finland Marin W Woman Europe Included Iceland Jakobsdottir W Woman Europe Excluded – Speeches not available on public domain Namibia Kuugongelwa W Woman Africa Excluded – Speeches not available on public domain
1 preprint medRxiv preprint
New Zealand Ardern W Woman Oceania Included (which wasnotcertifiedbypeerreview) Norway Solberg W Woman Europe Included Scotland Sturgeon W Woman Europe Included Serbia Brnabic W Woman Europe Speeches not available on public domain doi: Sint Maarten Jacobs W Woman Caribbean Included https://doi.org/10.1101/2020.09.10.20187427 Taiwan Ing-wen W Woman Asia Included
It ismadeavailableundera
istheauthor/funder,whohasgrantedmedRxivalicensetodisplaypreprintinperpetuity.
CC-BY-NC-ND 4.0Internationallicense ; this versionpostedSeptember15,2020.
.
The copyrightholderforthis
2 preprint medRxiv preprint
Appendix Table 2: COVID-19 context (which wasnotcertifiedbypeerreview)
Confirmed Confirmed Confirmed Confirmed Confirmed Deaths Total Cumulative Cumulative Cumulative Cumulative Cumulative Cases Per
Country Leader M/W Cases 29 Cases 31 Cases as 30 Cases 31 Cases 30 Per doi: Population51 Deaths52 Deaths53 Deaths54 Deaths55 Deaths25 Capita Feb52 March53 April54 May55 June25 Capita https://doi.org/10.1101/2020.09.10.20187427 Brazil Bolsonaro M 212,559,417 1 0 4256 136 71886 5017 465166 27878 1344143 57622 0.6324% 0.0271% Dominican Republic Medina M 10,847,910 0 0 901 320 6652 293 16908 498 31816 733 0.2933% 0.0068% It ismadeavailableundera France Macron M 65,273,511 57 2 43977 3017 127066 24054 148436 28717 156930 29739 0.2404% 0.0456%
India Modi M 1,380,004,385 3 0 1071 29 33050 1074 182143 5164 566840 16893 0.0411% 0.0012%
Indonesia Widodo M 273,523,615 0 0 1414 122 9771 784 25773 1573 55092 1783 0.0201% 0.0007% istheauthor/funder,whohasgrantedmedRxivalicensetodisplaypreprintinperpetuity.
Niger Issoufou M 24,206,644 0 0 20 3 713 32 956 64 1075 67 0.0044% 0.0003%
Russia Putin M 145,934,462 2 0 1837 9 106498 1073 405843 4693 647849 9320 0.4439% 0.0064%
South CC-BY-NC-ND 4.0Internationallicense Africa Ramaphosa M 59,308,690 0 0 1326 3 5350 103 30967 643 144264 2529 0.2432% 0.0043% ; this versionpostedSeptember15,2020. UK Johnson M 67,886,011 20 0 22145 1408 165225 26097 272840 38376 311969 43575 0.4595% 0.0642%
US Trump M 331,002,651 62 0 140640 2398 1003974 5428 1716978 101567 2537636 126203 0.7667% 0.0381%
Bangladesh Hasina W 164,689,383 0 0 49 5 7103 163 44608 610 141801 1783 0.0861% 0.0011%
Belgium Wilmès W 11,589,623 1 0 11899 513 47859 7501 58186 9453 61427 9747 0.5300% 0.0841%
Bolivia Añez W 11,673,021 0 0 97 5 1053 55 8731 300 31524 1014 0.2701% 0.0087%
Finland Marin W 5,540,720 2 0 1313 13 4906 206 6826 316 7209 328 0.1301% 0.0059%
Germany Merkel W 83,783,942 57 0 61913 583 159119 6288 181482 8500 194259 8973 0.2319% 0.0107% . New Zealand Ardern W 4,822,233 1 0 600 1 1129 19 1154 22 1178 22 0.0244% 0.0005% The copyrightholderforthis
Norway Solberg W 5,421,241 6 0 4226 26 7667 202 8411 236 8855 249 0.1633% 0.0046%
Scotland56 Sturgeon W 5,254,800 0 0 1993 69 11353 1475 15400 2362 18251 2485 0.3473% 0.0473% Sint Maarten Jacobs W 42,876 0 0 6 0 75 13 78 15 77 15 0.1796% 0.0350%
Taiwan Ing-wen W 23,816,775 39 1 322 5 429 6 442 7 447 7 0.0019% 0.0000%
3 preprint medRxiv preprint
(which wasnotcertifiedbypeerreview) doi: https://doi.org/10.1101/2020.09.10.20187427 It ismadeavailableundera istheauthor/funder,whohasgrantedmedRxivalicensetodisplaypreprintinperpetuity. CC-BY-NC-ND 4.0Internationallicense ; this versionpostedSeptember15,2020. . The copyrightholderforthis
4